{"id":28315,"date":"2026-03-01T02:00:23","date_gmt":"2026-03-01T02:00:23","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=28315"},"modified":"2026-02-27T13:01:43","modified_gmt":"2026-02-27T13:01:43","slug":"why-optometry-practices-missing-days-in-ar-benchmarks","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/why-optometry-practices-missing-days-in-ar-benchmarks\/","title":{"rendered":"Why Are Optometry Practices Missing Their Days in AR Benchmarks?"},"content":{"rendered":"

Optometry practices are missing their Days in AR Benchmarks<\/strong> because three compounding billing failures \u2014 vision-versus-medical plan misclassification, NCCI diagnostic bundling errors, and legacy ICD-10 coding after the October 2025 code update \u2014 are stalling claims in payer queues long after payment should have arrived.<\/p>\n

The national average sits at 35\u201340 Days in AR<\/strong> across eye care; high-performing optometry practices maintain under 28 days<\/strong>. For a multi-provider practice with $2M in annual allowable charges, every extra 10 days in AR represents $54,000 or more in delayed working capital<\/strong> \u2014 capital that cannot fund staff, equipment, or practice expansion while it sits in a payer queue.<\/p>\n

The Three Billing Failures Behind Missed Days in AR Benchmarks<\/h2>\n

Unlike primary care, optometry operates across two parallel insurance ecosystems simultaneously \u2014 medical plans and vision plans \u2014 and the revenue cycle must execute flawlessly in both or Days in AR Benchmarks slip. Most practices running above 35 days share the same three root causes:<\/p>\n

1. Chief Complaint Misclassification at Intake<\/h3>\n

When a patient presents with floaters, diabetic eye disease, or ocular pain, the correct billing destination is the medical insurance plan<\/strong> \u2014 reimbursing $120\u2013$180 per encounter. Practices that default to the vision plan for the same encounter collect $45\u2013$70.<\/p>\n

For a group seeing 30 patients daily, this systematic misclassification costs $200,000\u2013$275,000 in annual collections<\/strong> \u2014 and because under-billed claims settle quickly at the wrong rate, they appear to improve Days in AR while actually suppressing Net Collection Ratio. The metric looks better; the practice is losing more.<\/p>\n

2. NCCI Bundling Violations on Diagnostic Testing<\/h3>\n

The Medicare National Correct Coding Initiative (NCCI) creates hard bundling traps that most general billing systems are not equipped to catch. Billing OCT and fundus photography on the same date without documented separate medical necessity generates 8\u201312% denial rates on diagnostic testing alone<\/strong>.<\/p>\n

These denials do not simply delay payment \u2014 they enter the appeal cycle, adding 21\u201345 days to AR aging per claim. Specialized optometry billing services<\/a> with embedded NCCI edit monitoring catch these bundling conflicts before claims leave the practice.<\/p>\n

3. Legacy ICD-10 Codes After the October 2025 Update<\/h3>\n

Effective October 1, 2025, CMS released 487 new FY 2026 ICD-10-CM diagnosis codes including 17 new eye and adnexa codes<\/strong> covering Demodex blepharitis, neovascular glaucoma, and thyroid eye disease (CMS FY 2026 ICD-10-CM Official Guidelines).<\/p>\n

Practices still billing Demodex blepharitis with pre-October codes face automatic claim rejection across Medicare and commercial payers \u2014 converting routine encounters into AR aging events that inflate Days in AR within 30 days of implementation.<\/p>\n

Days in AR Benchmarks: What the Numbers Actually Mean for Eye Care Revenue<\/h2>\n

Days in AR is not simply an operational metric \u2014 it is a direct measure of how many days of earned revenue are sitting outside your bank account. The formula is straightforward: Total AR divided by Average Daily Charges. But the interpretation requires specialty context.<\/p>\n\n\n\n\n\n\n\n\n
Performance Tier<\/strong><\/td>\nDays in AR Benchmark<\/strong><\/td>\nPrimary Cause of Gap<\/strong><\/td>\nAnnual Revenue Impact ($2M Practice)<\/strong><\/td>\n<\/tr>\n
Elite (MBC clients)<\/strong><\/td>\nUnder 28 days<\/strong><\/td>\nNone \u2014 embedded claim scrubbing<\/td>\n+$120K vs. average<\/strong><\/td>\n<\/tr>\n
High-Performing<\/td>\n28\u201334 days<\/td>\nMinor plan misclassification<\/td>\nBreakeven on benchmark<\/strong><\/td>\n<\/tr>\n
Industry Average<\/td>\n35\u201340 days<\/td>\nNCCI bundling + code lag<\/td>\n\u2212$54K in delayed cash<\/strong><\/td>\n<\/tr>\n
Below Benchmark<\/td>\n41\u201355 days<\/td>\nChief Complaint errors + ICD-10 legacy codes<\/td>\n\u2212$150K+ in stalled AR<\/strong><\/td>\n<\/tr>\n
Crisis Level<\/td>\n56+ days<\/td>\nSystemic denial \u2192 AR aging \u2192 write-offs<\/td>\n\u2212$280K+ annually<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Source: MBC Optometry Center of Excellence client data; HFMA benchmarks; MGMA DataDive<\/em><\/p>\n

What 2026 Regulatory Changes Mean for Your Days in AR Benchmarks?<\/h2>\n

Two regulatory updates are compressing the margin for error in optometry billing this year \u2014 and both directly affect how quickly claims clear payer adjudication, which determines your Days in AR Benchmarks<\/strong>.<\/p>\n

    \n
  • CY 2026 MPFS Final Rule (effective January 1, 2026): <\/strong>CMS finalized two conversion factors \u2014 $33.57 for qualifying APM participants and $33.40 for non-qualifying practitioners (CMS CY 2026 PFS Fact Sheet<\/a>). A concurrent \u22122.5% efficiency adjustment applies to non-time-based services including diagnostic imaging and procedures. Practices running above the Days in AR benchmark absorb both lower reimbursement and longer collection cycles simultaneously.<\/li>\n
  • FY 2026 ICD-10-CM Update (effective October 1, 2025): <\/strong>The CMS release of 487 new diagnosis codes, including 17 new eye and adnexa codes, means any practice billing Demodex blepharitis, neovascular glaucoma, or thyroid eye disease with pre-October codes is generating automatic claim rejections that inflate Days in AR. These rejections do not trigger manual review \u2014 they are systemic denials that pile into AR aging silently (CMS FY 2026 ICD-10-CM Guidelines).<\/li>\n<\/ul>\n

    Specialized rcm services<\/a> for optometry practices update ICD-10 protocols the day CMS releases new codes \u2014 not 30 or 60 days later when claim rejections surface in your aging report.<\/p>\n